Opinion/Durac: RI must act now to safeguard ACA provisions

The Affordable Care Act has been a resounding success in Rhode Island, providing consumers with guaranteed access to affordable and high-quality health insurance. Nonetheless, the ACA is under attack, and after four years of chipping away by legislative and executive actions, it now faces an existential threat with the California v. Texas case set for oral argument before the U.S. Supreme Court on Nov. 10.

The passage of time makes it easy to overlook the breadth of the ACA’s impact on Rhode Island’s insurance market, but it’s important to reflect on the positive changes we’ve seen over the 10 years since its passage. In 2010, 12.2% of Rhode Islanders were without insurance coverage. There was only one insurer offering coverage in the individual market for people who did not have job-based insurance. And very-low-income adults could not get help with coverage unless they had children or disabilities.

By 2019, our successful implementation of the ACA helped us reach an uninsured rate of only 4.1%, the third-lowest in the country. Today, more than 86,000 non-disabled and non-parent Rhode Island adults (about 8.2% of the state) receive free, comprehensive insurance coverage through the ACA’s expansion of Medicaid, all through three health plans (Neighborhood, United and Tufts) consistently recognized as among the best in the country. Since 2014 (the first year of the HealthSource RI individual marketplace), Rhode Islanders have received more than $579 million in tax credits to make their health insurance coverage more affordable, about $100 million in each of the last two years.

Incredibly, in the context of seemingly ever-rising costs and premiums, the price of private plans on the HealthSource RI marketplace (as measured by the “benchmark” individual market premium) have been flat or declined for four of the last six years, including 2020. This has resulted in Rhode Island having the second-lowest individual market premiums in the country.

The loss of the Affordable Care Act would jeopardize all these gains. Medicaid Expansion enrollees would face losing their coverage in the middle of a pandemic that is entering a second peak. Tax credit recipients would see their premium bills skyrocket. And more than 460,000 Rhode Islanders with preexisting conditions could lose their insurance or be forced to pay more for their coverage.

That’s to say nothing of the many other crucial protections that would be threatened, including the prohibition of annual or lifetime limits on coverage (without which individuals with serious conditions could be on the hook for the full cost of their care), the availability of no-cost preventive services (which ensure consumers can be screened for serious conditions like cancer without copays), coverage of dependents to age 26, the prohibition on charging higher premiums to women, the elimination of the “doughnut hole” in Medicare drug plans, and many others.

While the dust settles at the federal level -- both at the Supreme Court and in the post-election White House and Congress -- there are important state-level actions that we can take right now to preserve our gains. The governor’s proposed 2020 budget included several of the most important ACA protections, including guaranteed availability of insurance coverage and no-cost preventive services. The General Assembly should pass these budget provisions or a standalone bill incorporating them, along with a prohibition on annual and lifetime limits to ensure that the consumers most at risk remain protected.

In the context of the most severe health crisis in at least a century, Rhode Islanders are fortunate to have benefited from the success of the Affordable Care Act. It is important for us to build on that success, on both the state and federal level, to safeguard the positive strides we’ve made in expanding the availability and quality of health care in our state.

Shamus Durac is an attorney and health policy analyst with the Rhode Island Parent Information Network (RIPIN), Rhode Island's health insurance consumer assistance program.

This article originally appeared on The Providence Journal: Opinion/Durac: RI must act now to safeguard ACA provisions

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